Lewisham Islamic Centre

YOUR DETAILS

Name *

First

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Telephone *

Mobile *

Email *

Age *

T-Shirt Size *

EMERGENCY CONTACT

Next of Kin Name *

Telephone *

Mobile *

HEALTH DETAILS

It is the responsibility of the runner to be fit to compete on the day of the run. If you have any medical issues which you think may put you at risk when running, see your GP prior to commencing on a training programme.

How is your health status? *

Excellent

Very Good

Good

Average

Poor

Do you have any of the following conditions? *

Asthma

Breathing Difficulties

Heart Condition

Diabetes

Other

No

If other, please specify below

1. You must be able to ﬁnish the run in 2 hours or under. 2. Runners must compete on foot. 3. You understand that you are participating entirely at your own risk. 4. The East London Mosque Trust (ELMT), its sponsors and suppliers, including local authorities and facilitating agencies will not be liable for any loss/damage, illness or injury whatsoever directly or indirectly, occasioned by or resulting from the negligence, wrongful act or any other cause of the runner. 5. The ELMT reserves the right at its absolute discretion to alter the date of the event or to change the published course as deemed necessary at any time and to alter without prior notice the contents of each race pack and event media partners. I also hereby give permission to pass my/our details to my chosen charity and to use my/our name, quotes, video footage and photographic likeness for marketing and promotional purposes. I also agree to the full Terms and Conditions as displayed on the event website.

I have understood the terms and conditions of the Muslim Charity Run and wish to register for a place. (Please tick to agree)

Muslim Charity Run is an initiative of the East London Mosque Trust and was previously known as Run 4 Your Mosque. This year it comes back bigger and better!